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Individual

ANVESH GAMPA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
6118 170TH ST FL 3, FLUSHING, NY 11365-1948
(206) 724-9095
Mailing address
6118 170TH ST FL 3, FLUSHING, NY 11365-1948
(206) 724-9095

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
041818
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
041818
PT LICENSE
NY
01
651579442
DRIVERS LICENSEE
NY
Enumeration date
03/14/2022
Last updated
03/14/2022
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